Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath |
NPI | 1063940773 |
---|---|
Provider Name | Dr. Kevin Carter Deyarmin |
First Address | South Fork, PA 15956-4123 |
Second Address | South Fork, PA 15956-4123 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2017 |
Last Update Date | 24/05/2017 |